When a child who stutters demonstrates the ability to change his speech during a treatment session, it seems obvious that he’d want to use the same strategies to improve speech outside the session as well. Children, especially teenagers, rarely want to stand out in a way that stigmatizes them, provokes questions or increases the chances of teasing. So the question arises, “Why aren’t they using their tools?!”
Speech and stuttering modification techniques are often learned quickly and easily within the treatment setting. However, SLPs and parents often feel discouraged when these tools seem to disappear as soon as the client gets to his car. Is it laziness on the part of the child? Is it the fault of the family for not following through with home assignments? Is the SLP not teaching the best strategies?
Instead of placing blame, consider the following three reasons a child may have difficulty generalizing his skills:
Reason # 1: These Techniques Are Too Hard!
Making changes to one’s speech becomes exponentially harder when you introduce factors that often are not present in the session, such as interruptions, time pressure and feelings of embarrassment or shame associated with stuttering. Learned escape/avoidance behaviors and increased language demands may make it very difficult to use these tools. Suddenly, what felt like an easy decision to use a new technique, becomes complicated by the person’s desire to be heard in a large group of chatty peers or by the need to formulate an excuse about why he doesn’t have his homework.
How Can I Help?
Children will be more likely to use speech/stuttering strategies if they are first introduced in safe and supportive environments (i.e. home, session room). To help with this, create a hierarchy of speaking situations and use it to guide where the client practices the strategies. If a child who stutters is not yet using speech tools in certain situations such as the classroom, it is probably because of where that situation is on his hierarchy. Work with your clients to determine where they would like to use their strategies , while also identifying those situations where they would prefer to concentrate on things other than using their tools.
Reason #2: These Techniques Make Me Sound Weird!
There are several techniques that may be taught to a child who stutters. Some strategies involve prolonging the initial sound to ease into or out of a word with less physical tension or struggle. Other techniques include inserting more pauses into speech. All speech tools require a child to alter their speech in a way that is still different from how his friends sound. Children may report that they have similar negative thoughts and feelings about using these strategies as they do about their stuttering. This may play a role in why they are choosing not to use speech strategies outside their sessions.
How Can I Help?
Just as you might spend time trying to help reduce negative reactions to stuttering, you might also spend time desensitizing clients to hearing themselves use strategies through voluntary stuttering assignments. Children can also benefit from improving their ability to handle listener reactions. This can be addressed by participating in role-playing activities that help the child create “scripts” for responding to curiosity/teasing. For example: “Why do you sound like that?” “Sometimes I stretch my sounds like that to help me get out of a stutter.” The more comfortable the child feels with his strategies and ability to respond to questions about his speech, the more prepared he will be to use these techniques outside the session.
Reason #3: These Techniques Aren’t Worth it!
A cost-benefit analysis can be useful when trying to understand why a child may choose not to use speech/stuttering strategies. At the surface, it may appear that there are many benefits of using strategies which include increased fluency and improved overall communication. However, SLPs and parents must be careful to consider the costs, as well. Costs may include increased effort, difficulty concentrating on the content of message, the risk of showing more stuttering and the potential that the strategy doesn’t work.
How Can I Help?
Have discussions with clients about what they perceive as potential costs versus benefits of using strategies in a variety of different speaking situations. As the child becomes more accepting of stuttering and is better able to tolerate both his feelings about stuttering and listener reactions, physical tension and struggles associated with speaking will decrease. As this happens, tools become easier to use and costs may not feel so high.
The bottom line
There are several strategies that may help reduce stuttering frequency and severity. However, you often can’t offer these tools without first considering and incorporating goals that target how the client thinks and feels about his speech both while stuttering and while using tools.
Brooke Leiman, MA, CCC-SLP, is the Director of the Stuttering Clinic at the National Speech/Language Therapy Center in Bethesda, Md. She is an affiliate of ASHA Special Interest Group 4, Fluency and Fluency Disorders. This blog post is adapted from a post on her blog, www.stutteringsource.com, which focuses on fluency disorders and their treatment.